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Metformin contrast and acute illness — GPhC CRA MCQ

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HardRenal and Hepatic ImpairmentMetformin contrast and acute illnessGPhC CRA

A man taking metformin has recovered from gastroenteritis-associated AKI. He is eating and drinking normally; eGFR has risen from 24 to 34 mL/min/1.73 m² and is stable on repeat testing. Which metformin plan is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Review and restart at an adjusted dose with renal monitoring

Metformin should be withheld during significant dehydration and AKI. Once the acute illness has resolved and renal function is stable, it may be reconsidered because eGFR is above the absolute 30 mL/min/1.73 m² threshold. At eGFR 30–44, the dose and ongoing need require review and renal function should be monitored; automatic resumption of the previous maximum dose is unsuitable.

Reference: NICE NG28, Initial medicines for adults with type 2 diabetes: https://www.nice.org.uk/guidance/ng28/chapter/initial-medicines